MEDICARE: TAMRA SUE PHILLIPS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1711	NE

General Provider Information

NPI Number	:	1679855530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMRA SUE PHILLIPS PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 34669
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-0669
Country	:	US
Telephone Number	:	402-932-6791
Fax Number	:	402-614-7835

Provider Business Practice Location Address
First Line	:	11901 PACIFIC ST STE 2
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-3421
Country	:	US
Telephone Number	:	402-401-6151
Fax Number	:	402-401-6181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/16/2021

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